EP0948337B1 - Behandlung von hämoglobin enthaltenden erythrozyten mit stickstoffoxyd - Google Patents

Behandlung von hämoglobin enthaltenden erythrozyten mit stickstoffoxyd Download PDF

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EP0948337B1
EP0948337B1 EP98929821A EP98929821A EP0948337B1 EP 0948337 B1 EP0948337 B1 EP 0948337B1 EP 98929821 A EP98929821 A EP 98929821A EP 98929821 A EP98929821 A EP 98929821A EP 0948337 B1 EP0948337 B1 EP 0948337B1
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blood
nitrosyl
hemoglobin
erythrocytes
diluent
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EP0948337A1 (de
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Takashi Yonetani
Antonio Tsuneshige
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Foryou Corp
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Foryou Corp
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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/795—Porphyrin- or corrin-ring-containing peptides
    • C07K14/805—Haemoglobins; Myoglobins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
    • A61K35/14—Blood; Artificial blood
    • A61K35/18—Erythrocytes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/41—Porphyrin- or corrin-ring-containing peptides
    • A61K38/42—Haemoglobins; Myoglobins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/06—Antianaemics

Definitions

  • the present invention relates to the use of nitric oxide to treat hemoglobin-containing erythrocytes in a diluent, including whole blood or at least one blood component, as well as compositions and methods of making and using thereof.
  • Carbon monoxide a well-known environmental pollutant
  • Hb hemoglobin
  • Hb hemoglobin
  • Its binding not only reduces the O 2 - binding capacity of Hb but also modifies Hb toward a high-affinity state rendering Hb incapable of delivering O 2 to peripheral tissues effectively.
  • the so-formed CO-bound Hb is highly stable and its toxic effect on the mammalian physiology is persistent and cumulative.
  • the U. S. Environmental Protection Agency specifies the occupational limits of CO to be 8 ppm for 9-hour, and 35 ppm for 1-hour. inhalation for the adult, respectively (The U.S.
  • nitric oxide also called nitrogen monoxide or NO
  • NO nitrogen monoxide
  • Nitric Oxide is produced in vivo by several different forms of NO synthases (NOS), it is present in very low concentrations in the blood (generally less than one micromolar). When present in the blood, as it is an uncharged diatomic molecule with limited stability, NO can readily penetrate through cellular structures and act as a paracrine on its primary target, soluble guanylyl cyclase, in local environments immediately after its production. Nitric oxide activates soluble guanylyl cyclase to produce cyclic guanosine monophosphate ( c GMP) which, in turn, initiates c GMP-dependent cascade reactions, leading to a wide range of biochemical, cellular. and physiological responses.
  • NOS NO synthases
  • Such responses result from a low steady-state concentration of NO ( ⁇ 1 ⁇ M) in the blood, which involve maintaining normal vascular tone and other necessary conditions for the systemic and pulmonary circulation.
  • a delicate balance exists between its production by NOSs and its sequestration, primarily by Hb in the erythrocyte. that maintains the homeostasis of the NO concentration in the plasma.
  • the concentration of NO in the plasma is sometimes altered during infection and inflammation and by administration of NOS inhibitors or NO-generating reagents, such as nitroglycerin and nitrite. Such changes can wreak havoc in the circulatory system.
  • Hb hemoglobin
  • U.S. Patent No. 5,122,539 (issued June 16, 1992) describes a new allosteric effecter, which decreases oxygen affinity of hemoglobin. Its structure is unrelated to 2.3-BPG, the natural allosteric effecter of the erythrocyte, but its function is similar. However, due to its chemical structure, this compound is expected to not pass through the erythrocyte membrane, such that this method will not have any practical applicability for treating blood or blood products to increase oxygen delivery.
  • Such a conversion results in the blood or blood products that are suitable for delivering O 2 to tissues in vivo .
  • Such methods and compositions can be used for treating whole blood and blood components, including cellular blood components, in order to render them suitable for transfusion.
  • the diluent can be any physiologically compatible solution, suspension or colloid (or mixture thereof). and can include whole blood or any blood components that also include erythrocytes ( i . e ., red blood cells or RBC's) from mammals. including humans.
  • the method can also include treatment of blood or blood components to rejuvenate their oxygen delivery capability.
  • a further object of the present invention is to provide compositions containing treated RBCs having most or all of the Hb in the ⁇ -nitrosyl-Hb form (or its oxygenated forms), and a diluent.
  • the diluent can be any solution. suspension or colloid (or combination thereof), and can include whole blood or any blood components that further include RBC's.
  • the diluent is preferably physiologically compatible.
  • a first embodiment of the present invention is directed to a method for treating an erythrocyte containing diluent, comprising adding NO to the diluent to provide at least 80 percent of the Hb in the erythrocytes as ⁇ -nitrosyl-Hb, or its oxygenated forms. and more preferably as at least 80-99.9999 percent, or any range or value therein, and preferably at least 95-99.9999 percent.
  • the blood components are cellular blood components, such as red blood cells (RBCs) and platelets, liquid blood components, such as plasma, or mixtures of cellular and/or liquid blood components.
  • a further embodiment of the present invention is directed to compositions comprising a diluent and erythrocytes having Hb, where at least 80-99.9999 percent of the Hb is in the form of ⁇ -nitrosyl-hemoglobin, or its oxygenated forms.
  • Such compositions include whole blood or blood components that have been stored and are then treated using methods of the present invention to provide such compositions, where the diluent is the treated whole blood or blood component, or is derived therefrom as a blood product, as known in the art.
  • the present invention lies in the discovery by the present inventors that nitric oxide (NO) does not reduce the oxygen delivery capacity of hemoglobin (Hb). as previously thought, but instead increases this capacity, due to the formation of ⁇ -nitrosyl Hb, which was not previously thought to play any important role in the metabolism of NO in the circulatory system.
  • NO nitric oxide
  • Hb in erythrocytes can be treated to form ⁇ -nitrosyl Hb (or an oxygenated form thereof), which forms can carry oxygen in a mammalian circulatory system with enhanced efficiency.
  • the present invention provides methods and compositions involving the treatment of hemoglobin (Hb) containing erythrocytes in a diluent (as any solution, suspension or colloid or any combination thereof), where most or all of the hemoglobin has been converted to ⁇ -nitrosyl Hb. or an oxygenated form thereof. such as ⁇ -nitrosyl, ⁇ -oxy Hb.
  • Hb hemoglobin
  • a diluent as any solution, suspension or colloid or any combination thereof
  • the present invention thus overcomes the long-standing problem of loss of bisphosphoglycerate (BPG) from stored blood and the resulting loss in oxygen delivery capacity of the blood and its unsuitability for use in transfusion.
  • BPG bisphosphoglycerate
  • the methods and compositions of the present invention thus provide a means to rejuvenate expired, stored blood and blood components, at time periods including and beyond those presently available, such as 2-4 weeks.
  • the present invention is thus also useful for increasing the oxygen delivery capacity of Hb in erythrocytes, by forming ⁇ -nitrosyl Hb, or its oxygenated forms, while the Hb remains intact in the erythrocytes.
  • the present invention also provides methods and compositions for making and using such treated erythrocytes and diluents or blood components comprising such treated erythrocytes.
  • blood components is intended to mean one or more of the components that can be separated from whole blood and include, but are not limited to, cellular blood components, such as red blood cells and platelets; blood proteins, such as blood clotting factors, enzymes, albumin, plasminogen, and immunoglobulins; and liquid blood components, such as plasma and plasma-containing composition.
  • cellular blood components such as red blood cells and platelets
  • blood proteins such as blood clotting factors, enzymes, albumin, plasminogen, and immunoglobulins
  • liquid blood components such as plasma and plasma-containing composition.
  • cellular blood component is intended to mean one or more of the components of whole blood that comprises celts, such as red blood cells or platelets.
  • liquid blood component is intended to mean one or more of the fluid, non-cellular components of whole blood, such as plasma (the fluid, non-cellular portion of the blood of humans or animals as found prior to coagulation) or serum (the fluid, non-cellular portions of the blood of humans or animals after coagulation).
  • composition or diluent containing blood or a blood component is intended to mean a composition or diluent that contains a physiologically compatible solution, and one or more blood components.
  • Such compositions can also contain a liquid blood component, such as plasma.
  • a "transfusible diluent or composition” is intended to mean a diluent or composition that can be transfused into the circulatory system of a mammal. such as human.
  • Transfusible compositions can contain whole blood, one or more blood components, such as one or more cellular blood components, one or more blood proteins, and one or more liquid blood components, or mixtures of whole blood and one or more blood components, such as clotting factors or plasma.
  • Such a diluent or composition of the present invention preferably comprises NO-treated erythrocytes of the present invention
  • extracellular pH is intended to mean the pH of the liquid medium in which cellular blood components, such as red blood cells, are stored or maintained.
  • a physiologically acceptable solution is intended to mean an aqueous solution which cellular blood components can be exposed. such as by being suspended therein, and remain viable, i . e ., retain their essential biological and physiological characteristics.
  • physiologically compatible solutions can preferably contain an effective amount of at least one anticoagulant.
  • a physiologically acceptable or compatible solution is also intended to mean a physiologically compatible solution having a pH and osmotic properties ( e . g , tonicity, osmolality and/or oncotic pressure) suitable for maintaining the integrity of the cell membrane of cellular blood components.
  • Suitable physiologically acceptable or compatible buffered solutions typically have a pH between 5 and 8.5 and are isotonic or only moderately hypotonic or hypertonic.
  • Physiologically compatible buffered solutions are known and readily available to those of skill in the art.
  • Illustrative examples of suitable solutions include, but are not limited to, those listed in Table I below.
  • Hb the widely assumed primary pathway of NO scavenging by Hb (Doyle, M.P., and Hoekstra, J.W., J. Inorg. Chem. 14 :351-358 (1981)) is not the principal pathway of NO removal in the blood. where the plasma concentration of NO ( ⁇ 1 ⁇ M) is substantially lower than the concentration of oxy Hb. Instead. free NO in the plasma binds to deoxy Hb in the erythrocyte to form partially nitrosylated Hb.
  • Hemoglobin which consists of two pairs of ⁇ - and ⁇ -subunits, each carries one O 2 -binding ferrous heme group.
  • the heme coordination structure in the ⁇ -subunits of deoxy Hb is more constrained than that in the ⁇ -subunits (Perutz, M.F.. Nature 228 :726-739 (1970)) and the heme Fe-His bonds in the ⁇ -subunits of deoxy Hb are weaker than that in the ⁇ -subunits (Nagai, K., and Kitagawa, T., Proc. Natl. Acad. Sci. USA 77 :2033- 2037 (1980)).
  • the ligation of NO to the ⁇ -subunits causes no breakage of the Fe-His bonds in the ⁇ -subunits.
  • the NO-induced bond cleavage occurs exclusively in the ⁇ -subunits in the physiological milieu.
  • the appearance of the sharp triplet EPR signals in the absence of IHP is. thus, a clear qualitative indication of the ligation of NO to the ⁇ -subunits.
  • Subunit structures and state of ligation of Hb are expressed by these conventions, where ⁇ , ⁇ , (Fe), (porphyrin), (Fe-NO), and (FeO 2 ) represent ⁇ -subunit, ⁇ -subunit, subunits containing deoxy heme, protoporphyrin IX, nitrosyl heme, and oxy heme, as a prosthetic group, respectively.
  • the subscripted number denotes the number of the subunits.
  • the intra-erythrocyte concentration of ⁇ -nitrosyl Hbs can sometimes reach as high as ⁇ 2% of the total heme of Hb or ⁇ 400 ⁇ M nitrosyl heme, when the plasma concentration of NO is abnormally increased by various causes (Kosaka, H., et al., Am. J. Physiol. 266 :C1400-C1405 (1994)).
  • whole blood is preferably drawn from a donor into a suitable physiologically compatible buffered solution containing an effective amount of at least one anticoagulant.
  • Suitable anticoagulants are known to those skilled in the art, and include. but are not limited to. heparin. lithium, potassium or sodium oxalate (15 to 25 mg/10 mL blood), sodium citrate (40 to 60 mg/10 mL, blood), heparin sodium (2 mg/10 mL, blood), disodium EDTA (10 to 30 mg/10 mL whole blood) or ACD-Formula B solution (1.0 mL/10 mL blood).
  • the whole blood so collected can then be treated according to the methods of the present invention.
  • the whole blood can first be separated into blood components, including, but not limited to, plasma, platelets and red blood cells, by any method known to those of skill in the art.
  • blood can be centrifuged for a sufficient time and at a sufficient centrifugal force to sediment the red blood cells.
  • Leukocytes collect primarily at the interface of the red cells and the plasma-containing supernatant in the buffy coat region.
  • the supernatant which contains plasma, platelets, and other blood components. can then be removed and centrifuged at a higher centrifugal force. whereby the platelets sediment.
  • Human blood normally contains about 7 x 10 9 leukocytes per liter.
  • concentration of leukocytes which pellet with the red cells, can be decreased by filtering through a filter that decreases their concentration by selected orders of magnitude.
  • Leukocytes can also be removed from each of the components by filtration through an appropriate filter that removes them from the solution.
  • the whole blood or blood component to be treated is obtained in, prepared in or introduced into gas permeable blood preservation bags, which are sealed and flattened to a width sufficiently narrow to permit light to irradiate the contents, such that any pathogenic contaminant present in the blood or blood component in the bag will be irradiated.
  • Any such blood bag known to those of skill in the art can be used provided that the bag is transparent to the selected wavelength of light.
  • the gas permeable blood preservation bag also contains oxygen.
  • composition that is to be treated can also include any suitable physiologically compatible buffer known to those of skill in the art.
  • suitable physiologically compatible buffers include, but are not limited to, Unisol and ARC 8.
  • the whole blood can be stored or transfused.
  • the composition can be centrifuged at a force sufficient to pellet the cellular components. The supernatant can be removed following centrifugation and the cells resuspended to reduce the concentration of residual products.
  • the following method provides treated erythrocytes having most or all of the Hb present as at least 80-99.99 percent ⁇ -nitrosyl-Hb.
  • Erythrocytes as starting material . If using erythrocytes in solution, then erythrocytes in a suitable buffer solution can preferably be used with a slightly acidic buffer, such as pH 5-6.5, or any range or value therein.
  • a slightly acidic buffer such as pH 5-6.5, or any range or value therein.
  • anti-coagulated blood can be suspended in an excess volume of chilled buffer solution, which can contain a sugar.
  • the solution is preferably isotonic.
  • sugar solutions include, glucose, sucrose, maltose and/or fructose, 25-500 mM, such as 25-100, 100-250, 250-500 mM, or any range or value therein. Any known and suitable salt buffers can be used.
  • the solution can then be centrifuged at 500-3000g for 3-90 minutes at 4-20 degrees C. or any range or value therein. The supernatant and/other layers ( e .
  • the buffy layer of leukocytes can be removed and stored or discarded, and the precipitate of erythrocytes can be re-suspended in a fresh buffer solution, such as an isotonic sucrose solution.
  • the centrifugal washing procedure can then be repeated 0-5 times.
  • the final concentration of hemoglobin in the washed erythrocytes is then determined using known methods. and can be preferably about 2-30mM heme (or ca. 0.5-7.5mM tetrameric hemoglobin). and preferably about 10-30 mM.
  • the loosely packed precipitate of washed erythrocytes can then optionally be re-suspended in an excess volume ( e . g ., 1.5-10 times, preferably 1.5-4 times) of chilled buffer, pH 5-6.2, preferably 5.6-6.0. or any ranges or values therein).
  • the isolated erythrocytes can be preferably deoxygenated using any known and suitable methods.
  • argon or nitrogen gas can be used to displace and remove the oxygen from the Hb in the erythrocytes. Observing the change in the color of the erythrocyte suspension readily follows the progress of deoxygenation. After prolonged deoxygenation, the color changes from bright red (of oxy hemoglobin) to deep purple (of deoxy hemoglobin).
  • Nitric Oxide Treatment To treated the resulting or stored erythrocytes, NO is contacted with the erythrocytes (preferably deoxygenated) to form mostly or all ⁇ -nitrosyl hemoglobin, using any suitable method, including contacting NO in the form of a gas, solid or liquid with the erythrocytes, such that at least 80-99.9999% of the Hb in the erythrocytes forms ⁇ -nitrosyl Hb, or its oxygenated forms, such as, but not limited to, ⁇ -nitrosyl, ⁇ -oxy Hb.
  • NO is contacted with the erythrocytes (preferably deoxygenated) to form mostly or all ⁇ -nitrosyl hemoglobin, using any suitable method, including contacting NO in the form of a gas, solid or liquid with the erythrocytes, such that at least 80-99.9999% of the Hb in the erythrocytes forms ⁇ -nitrosyl Hb, or its oxygenated forms, such as, but not limited to,
  • a 2-20 fold excess (to heme) quantity of a solution of sodium dithionite (Na 2 S 2 O 4 ) or organic nitrosothiols such as nitrosoglutathione and S-nitrosocysteine can be added into the erythrocyte suspension and can then be mixed for 1-1000 minutes (or any range or value therein), and then can be preferably chilled (0-20 degrees C).
  • An excess (e . g ., 51-80%. such as 52-55%) equivalent (to heme) quantity of a solution of sodium nitrite (NaNO 2 ) or organic nitrosothiols can then be introduced into the erythrocyte suspension.
  • Sodium nitrite reacts stoichiometrically and immediately with sodium dithionite and forms nitric oxide that combines with the ⁇ -heme groups of hemoglobin to form ⁇ -nitrosyl Hb.
  • a slightly acidic pH pH 5.0-6.5, such as 5.8 can optionally be used to promote the formation of ⁇ -nitrosyl hemoglobin.
  • a ca. 1-10% e . g ., 2-5%
  • excess of nitrite or organic nitrosothiols can be added to ensure the ligation of NO to all the ⁇ -subunits of hemoglobin and thus reducing the possibility of unreacted hemoglobin molecules remaining.
  • the addition of a large excess of sodium nitrite or organic nitrosothiols into the suspension is preferably avoided because the ligation of NO to the ⁇ -subunits can occur using larger quantities of nitrite.
  • the resulting suspension can then be stored for 5-500 minutes in cold (0-25 degrees C, such as 4 degrees C) and then optionally washed with isotonic, deoxygenated isotonic sugar solution, e . g ., to remove excess reagents and reaction byproducts.
  • oxygenated ⁇ -nitrosyl Hb is to be used or is desired
  • the treated erythrocyte suspension can be exposed to air or an oxygen-containing gas (or mixture thereof) to produce oxygenated ⁇ -nitrosyl hemoglobin (e . g ., ⁇ -nitrosyl, ⁇ -oxy hemoglobin ( ⁇ (Fe-NO) 2 ⁇ ((Fe-O 2 ) 2 )).
  • Electron paramagnetic resonance spectroscopy (EPR) can then optionally be used ( e . g ., as described in Example 1) to confirm the amount of formation of desired product.
  • the resulting erythrocytes containing ⁇ -nitrosyl hemoglobin can be stored at 0-15 degrees C for 1-120 days before use. e . g ., to be added to other blood components for transfusion.
  • erythrocytes as described herein, can be treated with NO gas, or with NO formed from alternative chemical reactions as known in the art. in order to provide treated erythrocytes according to the present invention.
  • the NO provided by a chemical reaction can be added to the erythrocytes after, during or before the chemical reaction has taken place to produce the NO.
  • ⁇ -nitrosyl compounds can be applied to purified hemoglobin or liposome-encapsulated hemoglobins or other hemoglobin substitutes. It can also be applied to any hemoglobin-like substances. which are able to carry out oxygen atoms.
  • the purified or modified hemoglobin mentioned here directs any or partial or full, chemical or genetical modifications, including products with natural occurrence but consisted of any different amino acid sequence or with recombinant gene technology. to the subunits of those hemoglobins. All of the possible modifications to the combination of hemoglobin subunit molecules, and any kind of chemicaly cross-linked hemoglobins are directed as well.
  • Liposome-encapsulated hemoglobin with phospholipids and any kind of material that contributes to the formation of liposome for the encapsulation, or hemoglobin encapsulating at any form. or any artificial compound or agent which is able to transport oxygen, are also included in the scope of the present invention.
  • the present invention also encompasses purified ⁇ -nitrosyl Hb, liposome-encapsulated ⁇ -nitrosyl Hb and other ⁇ -nitrosyl hemoglobin substitutes, as well as ⁇ -nitrosyl hemoglobin-like substances which may carry oxygen atoms as long as it serves as hemoglobin.
  • Hb permanently locks itself into a new. extremely low-affinity functional state. termed the Low-Affinity Extreme state (Fujii, M., et al., J. Biol. Chem. 268 :15386 (1993)).
  • An artificially synthesized Hb hybrid, ⁇ (porphyrin) 2 ⁇ (Fe) 2 (Fujii, M., et al., J. Biol. Chem. 268 : 15386 (1993)).
  • HbM Iwate ( ⁇ 58 His ⁇ Tyr) (Hayashi, A., et al., J. Biol. Chem. 241 :79-84 (1966)) and HbM Boston ( ⁇ 57 His ⁇ Tyr) (Suzuki. T., et al., Biochem. Biophys. Res . Commun. 19 :691-695 (1965)) represent such a state.
  • the coordination structures of the prosthetic groups in their ⁇ -subunits are schematically compared in Fig. 1B, C, and D, respectively.
  • Hbs are functionally characterized as a non-cooperative, non-allosteric, extremely low-affinity state: oxygen-binding curves of these Hbs are hyperbolic (non-cooperative) with extremely low O 2 -affinity and insensitivity to pH (no Bohr effect) and organic phosphates (non-allosteric).
  • the Low-Affinity Extreme state of ⁇ -nitrosyl Hb, ⁇ (Fe-NO) 2 ⁇ (Fe) 2 changes reversibly to a High-Affinity state upon oxygenation. in contrast to HbM Iwate and HbM Boston . whose Low-Affinity Extreme states are permanent and independent of oxygenation.
  • the equilibrium between the 5- and 6-coordinate ⁇ -nitrosyl heme species of ⁇ (Fe-NO) 2 ⁇ (Fe) 2 is a complicated function of interactions with O 2 , H, and organic phosphates like 2,3-bisphosphoglycerate (BPG) and IHP (Fig.3).
  • the 6-coordinate species are favored in the increased O 2 saturation at higher pH (Fig. 2D), whereas the 5-coordinate species (a Low-Affinity Extreme state) is dominant in the absence of O 2 and in the presence of IHP at lower pH (Fig. 2C).
  • Oxygenation-induced shifts in the coordination equilibrium are larger at higher pH, whereas it becomes progressively smaller at lower pH (Fig. 4).
  • pH4.8 in the presence of IHP the ⁇ -nitrosyl hemes of ⁇ (Fe- NO) 2 ⁇ (Fe) 2 become essentially a ( ⁇ 100%) 5-coordinate (Fig.
  • Alpha-nirosyl Hb, ⁇ (Fe-NO) 2 ⁇ (Fe) 2 shows the O 2 -binding behaviors (Fig. 5) predicted from the results of the EPR measurements of its coordination equilibrium mentioned above (Fig.4).
  • Alpha-nitrosyl Hb behaves as a cooperative, high-affinity O 2 carrier at alkaline pH, much like the partially CO-bound Hb (Fig. 5D). It becomes an essentially non-cooperative, low-affinity O 2 carrier at acidic pH (Fig. 5A), just like permanent Low-Affinity Extreme Hbs such as ⁇ (porphyrin) 2 ⁇ (Fe) 2 , HbM Iwate and HbM Boston .
  • ⁇ - nitrosyl Hb, ⁇ (Fe-NO) 2 ⁇ (Fe) 2 can be transformed to a series of High-Affinity, Low-Affinity , and Low-Affinity Extreme states of Hb by controlling the binding of O 2 , H + , BPG or IHP.
  • Oxygen-binding characteristics of the intra-erythrocyte ⁇ -nitrosyl Hb (Fig. 6) essentially confirm those of the solution data (Fig. 5), except that effects of organic phosphate cannot be quantitatively estimated, as they are impermeable to the erythrocyte membrane. Furthermore. the intra-erythrocyte levels of BPG can vary according to the age and metabolic activity of the erythrocyte and the conditions of storage and experimental medium. Nevertheless, it is clear that ⁇ - nitrosyl Hb in the erythrocyte is unexpectedly capable of delivering O 2 to tissues more effectively than Hb, though it has only one-half of the O 2 -carrying capacity of Hb.
  • Oxy Hb, ⁇ -nitrosyl Hb and tetra- nitrosyl Hb are eventually oxidized to met Hb under aerobic conditions at higher temperatures, whereas the sequestered NO is never released from the ⁇ -hemes as free NO. Instead, it is oxidized to nitrate.
  • Half-times of oxidation to met Hb of 39, 29, and 27 hours at 15°C decrease to 780, 120, and 38 minutes at 37°C for oxy Hb, ⁇ - nitrosyl Hb and tetra- nitrosyl Hb, respectively.
  • the formed met Hb is recycled to bioactive Hb by Hb reductase within the erythrocyte and nitrate is excreted to complete the NO scavenging.
  • nitroglycerin-induced formation of ⁇ -nitrosyl Hb is only less than 2% of the total heme of Hb (Kosaka, H., et al., Am. J. Physiol. 266 :C1400-C1405 (1994)). Therefore, the reported observation is, in fact. the definitive proof that some factors other than ⁇ -nitrosyl Hb are apparently responsible for the observed increase in the O 2 delivery to the tissue.
  • the NO locally generated near pre-capillary small vessels without vascular smooth muscles could transform substantial amounts of Hb to ⁇ - nitrosyl Hb, allowing more efficient local delivery of O 2 to peripheral tissues, especially under acidic conditions.
  • the metabolically active brain the organ that is most sensitive to hypoxic damage, has no obvious mechanism of protection against anoxia/hypoxia.
  • high levels of NOSs exist in the brain. It can be that some of these NOSs can be involved in the activation of Hb to ⁇ -nitrosyl Hb for more effective delivery of O 2 to circumvent anoxia/hypoxia to the organ.
  • the effect of the locally generated NO on the O 2 saturation of the intra-erythrocyte Hb in pre- and post- capillary small vessels must be measured to answer such a hypothesis.
  • NO binds to Hb as a "negative allosteric" ligand during its initial binding to the ⁇ -subunits at acidic and neutral pHs and that O 2 acts as a homotropic (or "positive allosteric") ligand in the subsequent binding to the ⁇ -subunits. Since its bond-breaking ability is diminished at higher pH. NO binds to Hb solely as a homotropic ligand at alkaline pH, analogous to any other diatomic ligands (CO and O 2 ). Therefore, ⁇ - nitrosyl Hb behaves like a partially CO-bound Hb during oxygenation at alkaline pH (Fig. 4D).
  • Hb transforms itself into ⁇ -nitrosyl Hb, a new O 2 carrier that is more efficient than normal Hb in O 2 delivery to peripheral tissues where pH is more acidic due to high metabolic activities.
  • This feat is accomplished by utilizing the unique property of NO that can break the trans-axial Fe-ligand bond and by adapting a constrained heme coordination structure in its ⁇ -subunits that readily responds to NO by breaking the Fe-His bonds. This explains why NO causes no acute adverse effect on newborn infants during clinical treatments with inhaled NO, although NO has a substantially higher (>10 3 ) affinity for Hb than CO. the culprit of respiratory CO poisoning.
  • Hemoglobin can function simultaneously as a NO scavenger as well as an efficient O 2 carrier in the hostile environment of the blood, where NO, a high-affinity ligand, is always present.
  • ⁇ - nitrosyl Hb was prepared by an aerobic, stoichiometric combination of isolated nitrosylated ⁇ -subunits and isolated oxy ⁇ -subunits of human Hb.
  • the resultant product, ⁇ (Fe-NO) 2 ⁇ (Fe-O 2 ) 2 was used immediately or stored at liquid nitrogen temperature.
  • Nitric oxide is so tightly bound to the ⁇ -subunits (an estimated K D ⁇ 10 -15 M) that neither detectable escape of NO from the ⁇ -subunits to media nor inter-subunit transfer of NO to the ⁇ -subunits has been observed during preparation, experiments. and storage, as long as the ⁇ -subunits are kept ligated. On the other hand.
  • EPR measurements were carried out with a Varian E106 X-band EPR spectrometer operated at 9.1lGHz with field modulation of 100kHz, modulation amplitude of 2.0 gauss, and microwave power of 20mW at liquid nitrogen temperature.
  • Hemoglobin preparations which were dissolved at 0.5mM heme in appropriate buffers, were oxygenated by purging with pure O 2 gas or deoxygenated by repeated vacuum evacuation/purging with O 2 -free argon gas at 15°C for 30 min prior to freezing for EPR measurements.
  • Oxygen equilibrium measurements were carried out with a modified version of the Imai cell (Imai, K., Allosteric Effects in Hemeoglobin, Cambridge University Press, London (1982)) using either an Olis-Cary 118 dual-beam spectrophotometer (Bogart, Georgia) for solution or an Olis-Hitachi 557 dual-wavelength spectrophotometer (Bogart, Georgia) for erythrocyte suspension.
  • compositions of the present invention are suitable and useful for treating erythrocytes with NO to enhance oxygen delivery of Hb in erythrocyte containing solutions.
  • erythrocyte containing solutions such as whole blood and blood components or derivatives.
  • Hb partially NO-bound hemoglobin
  • ⁇ - nitrosyl Hb has been demonstrated to have a low O 2 -affinity, having a right-shifted O 2 -binding curve, analogous to Hb in the presence of BPG. Therefore, we proposed the idea of converting the normal Hb in the stored blood to ⁇ - nitrosyl Hb to improve its efficiency of O 2 delivery of the expired blood.
  • compositions of the present invention are suitable and useful for treating erythrocytes with NO to enhance oxygen delivery of Hb in erythrocyte containing solutions, such as whole blood and blood components or derivatives.
  • Nitric oxide (NO) acts as a regulator of a number of vital cellular, physiological and biochemical reactions, principally by activating soluble guanylate cyclases in production of cGMP, a second messenger in signal transduction in various tissues.
  • Nitric oxide in the blood is well maintained at a steady-state level of the order of micromolar by the dynamic balance between the continuous supply of NO by endothelial NO syntheses and other sources and the rapid scavenging of NO by oxy hemoglobin ( oxy Hb) in the erythrocytes.
  • oxy Hb oxy hemoglobin
  • Nitric oxide in the blood rapidly diffuses into erythrocytes and reacts with oxy Hb to form met Hb and NO 2 - /NO 3 - .
  • Met Hb so formed is immediately reduced to deoxy Hb by active met Hb reductase in the erythrocytes.
  • the relative concentration of NO ( ⁇ 1 ⁇ M in plasma) with respect to that of Hb (20 mM heme in the erythrocytes) is very limited in the blood. Under such conditions. NO converts deoxy Hb preferentially to ⁇ -nitrosyl Hb [ ⁇ (Fe-NO) ⁇ (Fe) ⁇ (Fe) 2 or ⁇ (Fe-NO) 2 ⁇ (Fe) 2 ].
  • the NO in the blood facilitates increased oxygen delivery to tissues through the vasodilation as well as the formation of an allosteric, low-affinity Hb, ⁇ (Fe-NO) 2 ⁇ (Fe) 2 .
  • Binding of NO to Hb as well as soluble guanylate cyclase causes the trans-axial breakage of the Fe-His bond in their heme prosthetic groups, resulted in alteration of their protein conformation (to the T-(low-affinity extreme) low-affinity state in Hb and to the activated state in soluble guanylate cyclase).
  • the unique feature of NO as the physiological regulator relies solely on its unique coordination property to transaxially break the heme Fe-His bond upon ligation. due to its preference to a 5-coordinated heme structure over a 6-coordinate state.
  • compositions of the present invention are suitable and useful for treating erythrocytes with NO to enhance oxygen delivery of Hb in erythrocyte containing solutions, such as whole blood and blood components or derivatives.
  • the following method provides treated whole blood having most or all of the Hb present as at least 80-99.99 percent ⁇ -nitrosyl-Hb.
  • the erythrocyte containing diluent is provided in a physiologically compatible buffer and the treatment method comprises
  • the final concentration of hemoglobin in the loosely packed, washed erythrocytes is approximately 20mM heme (or ca. 5mM tetrameric hemoglobin).
  • the loosely packed precipitate of washed erythrocytes is re-suspended in a 2-volume of chilled 0.15M sodium-potassium phosphate buffer, pH 5.8 (The phosphate buffer is prepared by mixing 0.15M Na 2 HPO 4 and 0.15M KH 2 PO 4 to adjust the pH to 5.8.), transferred into a 300ml-Kieldahl type flask with a rubber stopper, to which two stainless-steel gauge 20 needles with three-way stopcocks are inserted in.
  • the erythrocyte suspension is gently stirred for one minute and let stand on ice for 10 minutes.
  • a 52-55% equivalent (to heme) quantity of a freshly prepared 50mg/ml solution of sodium nitrite (NaNO 2 ) is injected into the suspension through the needle.
  • sodium nitrite reacts stoichiometrically and immediately with sodium dithionite and forms nitric oxide that combines with the ⁇ -heme groups of hemoglobin.
  • the slightly acidic (pH5.8) sucrose buffer of the suspension promotes the formation of ⁇ -nitrosyl hemoglobin.
  • a ca. 2-5% excess of nitrite added is to ensure the ligation of NO to all the ⁇ -subunits of hemoglobin and thus reducing the possibility of unreacted hemoglobin molecules remaining.
  • the addition of a large excess of sodium nitrite into the suspension must be avoided because the ligation of NO to the ⁇ -subunits occurs at larger quantities of nitrite.

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Claims (10)

  1. Verfahren zur Verarbeitung eines Verdünners, der Hämoglobin enthaltende Erythrozyten umfasst, um die Sauerstoff-Abgabekapazität des Hämoglobins zu erhöhen, wobei das Verfahren umfasst:
    (a) das Desoxidieren des Verdünners; und daraufhin
    (b) das Zugeben von Stickstoffoxid (NO) zum Verdünner, um einen NO-behandelten Verdünner zu bilden, der Erythrozyten aufweist, die Hämoglobin als zumindest 95 % α-Nitrosyl-Hämoglobin umfassen; sowie
    (c) das Gewinnen des NO-behandelten Verdünners; und
    (d) das Oxidieren des NO-behandelten Verdünners.
  2. Verfahren nach Anspruch 1, worin das α-Nitrosyl-Hämoglobin im NO-behandelten Verdünner als zumindest 99 % des Hämoglobins vorhanden ist.
  3. Verfahren nach Anspruch 1, weiters umfassend das Zugeben zumindest einer Blutkomponente zum NO-behandelten Verdünner, wodurch eine zur Transfusion in ein Säugetier geeignete Blutzusammensetzung gebildet wird, wobei die Blutzusammensetzung bezogen auf den Verdünner in nicht-verarbeitetem Zustand verbesserte Sauerstoff-Abgabekapazität aufweist.
  4. Verfahren nach Anspruch 1, worin das NO zugegeben wird, indem das NO als Produkt einer chemischen Reaktion im Verdünner erzeugt wird.
  5. Verfahren nach Anspruch 4, worin die chemische Reaktion während des Zugabeschritts stattfindet.
  6. Verfahren nach Anspruch 1, worin NO zugegeben wird, indem NO direkt mit dem Verdünner in Kontakt gebracht wird.
  7. Verfahren nach Anspruch 1, worin der Verdünner Vollblut oder zumindest eine Blutkomponente umfasst.
  8. Verfahren nach Anspruch 7, worin das Vollblut oder die zumindest eine Blutkomponente zumindest 3 Wochen lang gelagert worden ist.
  9. Durch ein Verfahren nach Anspruch 1 erhältlicher NO-behandelter Verdünner.
  10. Verfahren nach einem der Ansprüche 1 bis 8, worin die Erythrozyten Human-Erythrozyten sind.
EP98929821A 1997-07-03 1998-07-03 Behandlung von hämoglobin enthaltenden erythrozyten mit stickstoffoxyd Expired - Lifetime EP0948337B1 (de)

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EP1514103A4 (de) * 2002-05-29 2006-05-24 Univ Duke Messung von stickstoffmonoxid in blutgasen und darauf beruhende behandlungen
WO2004054433A2 (en) 2002-12-12 2004-07-01 Duke University Forming iron nitrosyl hemoglobin
US20070148136A1 (en) * 2003-09-26 2007-06-28 Whitlock David R Methods of using ammonia oxidizing bacteria
CN1905901A (zh) * 2004-01-29 2007-01-31 学校法人庆应义塾 红细胞功能修饰物质
CA2600927C (en) 2005-03-07 2017-04-18 Sangart, Inc. Compositions and methods for delivering carbon monoxide (co) and nitric oxide (no) to tissue using heme proteins as carriers
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